Wondering what is new in the ongoing discussion on Hormone Therapy Replacement? On the heels of the 2015 National American Menopause Society (NAMS) Meeting, we wanted to keep you up to date on the latest groundbreaking medical updates for women. The NAMS conference raised many medical issues that women need to know. We are going to give you all the highlights and important updates here in our column!
Dangers of Stopping Hormonal Therapy, Especially Before Age 60
New research is showing that there are increased cardiovascular and stroke risks during the first year AFTER stopping hormone therapy. This data comes from an observational study of women on hormone replacement therapy in Finland. This is important because many physicians who are unfamiliar with the risks and benefits of hormone replacement therapy take patients off hormones early and could be causing significant harm. There is no time limit to using hormone therapy and stopping hormone therapy may actually be risky!
Using a mathematical formula, research estimates that a minimum of 18,601 women and a maximum of 91,610 women may have died prematurely because of hormone therapy avoidance after the publication of the Women’s Health Initiative data in July 2002.
Discontinuing hormones at the age of 60 because of older data should be carefully RE-considered and the decision should be made jointly by you and your physician. If you are taking hormone therapy or are considering seeing a provider for hormone therapy, seek out a NAMS certified practitioner (NCMP).
Also, more research is also showing more cardiovascular benefits if a woman is started on hormone replacement therapy within the first 10 years of menopause.
Perimenopause, skipping periods or if you are in your 40s or even 50s is simply NOT a reason to think you cannot get pregnant.
Many women in their late 40s and early 50s come with irregular periods and are not using contraception. These women often don’t take contraception as they don’t think they have a high chance of becoming pregnant.
We know that the highest age group of contraception non-users is no longer in adolescents, but in women between the ages of 40-44. It is imperative to talk to your doctor about contraception if you no longer desire to bear children.
Migraines During Perimenopause
Also, many women who are prone to migraines or headaches come to their physician with migraines worsening in perimenopause. The good news for migraine sufferers is that the CDC is now reconsidering its warning that migraine headaches are a contraindication to taking oral contraceptive pills. This is because more research is showing that women who suffer from migraines who take a steady dose of hormones on a daily basis see a reduction in migraine headache frequency.
Perimenopause can be a challenging and confusing time but there are many treatment options. See our new downloadable treatment guidebook on perimenopause for more information.
The Bimanual Exam: Pros and Cons
Many women make their annual GYN appointment and expect to have a bimanual pelvic exam by a physician. Often women do not report any lower pelvic symptoms, but are accustomed to having them performed, which provides comfort and reassurance.
However, it is being found that there may be risks and harms associated with bimanual exams when a women is asymptomatic, such as unnecessary follow up with imaging tests or invasive biopsies and surgeries.
Therefore, some doctors are discussing these new recommendations with patients to limit annual bimanual exams if they are not needed. If you need a pap smear or have new symptoms, then an exam is warranted. The following are all very important reasons to have a pelvic exam:
- Bladder concerns
- Pelvic concerns
- Sexual function concerns
New Medication for Low Libido
Much talk surrounded the new drug Flibanserin, also known as Addyi, the first oral female medication for women suffering from low sexual desire and drive. Its mechanism of action is not entirely clear, but it works partly by modulating serotonin, which is a sexual satiety signal.
Addyi is available now, but physicians must be certified to prescribe this medication. It is approved for pre-menopausal women and has been shown to increase desire. It is NOT an aphrodisiac. It is a pill that must be taken at night, and cannot be taken with any alcohol as lightheadedness and passing out can occur.
Another drug called bremelanotide, classified as a melanocortin, is currently in phase 3 trials. This drug has had promising results and works by increasing sexual attention and desire.
The North American Menopause Society stands strongly on its recommendation to avoid the use of any hormone therapy that is not regulated by the FDA.
These hormones can be dangerous to patients, putting them at risk for endometrial cancers due to unopposed levels of estrogen. They can also contain too much testosterone that leads to the following symptoms:
- hair loss
- oily skin
- unwanted growth of facial hair
Women tend to seek out unregulated hormones when their provider is unwilling to discuss hormone therapy with them. Be proactive and seek a NAMS certified practitioner who can help you, so that you don’t turn to unregulated compounded hormones that could be dangerous to your health.
Be Strong. Be Healthy. Be in Charge!
-Elim Shih MD, NCMP and Heather Hirsch MD, MS, NCMP
- Bioidentical Hormone Therapy: Clarifying the Misconceptions
- Menopause: Is It Starting?
- Surviving Menopause Series: Bioidentical Hormone Therapy
- Menopause Quiz: Is Hormone Therapy Right for You?
- Women Now Have A New ‘Little Pink Pill’ for Low Sex Drive
- Is the “Pink Viagra” Finally Here?
- What is Perimenopause?
- What is Perimenopause?